Abstract
IntroductionThe Expanded Program on Immunisation (EPI) has been operational in Eritrea since 1980. Eritrea has endorsed the resolution of the Regional Committee of the World Health Organisation African region, committing to a measles elimination goal for 2020 in the African Region. The country is implementing the recommended strategies.MethodsWe reviewed administrative coverage and WHO UNICEF coverage estimates for Diphtheria-Pertussis-Tetanus (DPT) and measles routine vaccination, as well as for measles supplemental immunization activities. We reviewed national surveillance performance and analyzed the epidemiological trends of measles as reported in the case-based surveillance database.ResultsEritrea has maintained more than 90% coverage with the first dose of measles vaccine at national level since 2001 and 88% MCV2 coverage from 2015 - 2017 according to the WHO-UNICEF coverage estimates. Since 2011, the country has not met the surveillance performance target of at least 80% districts reporting suspected measles cases with blood specimen. Measles incidence was between 16.8 - 24.7 cases per million population in the period 2015 - 2018. The mean and median age of confirmed measles cases was more than 10 years in 8 of the 14 years covered by the analysis. In 2017, Eritrea reported 1,199 cases of measles which differs significantly from the 185 suspected cases in the case based surveillance database for the same year. Eritrea has maintained high coverage for MCV1 and MCV2 and made progress towards measles elimination. However, the country has gaps in surveillance performance which may mask the true incidence of measles.ConclusionIn order to attain elimination of measles, Eritrea needs to implement measures to improve surveillance quality, to conduct regular risk assessment and implement targeted measures to close immunity gaps. In addition, setting up a national committee for the verification of measles elimination will help the country document progress and also to highlight and advocate for addressing issues related to data quality and performance gaps.
Highlights
Eritrea has a projected total population of 3,905,066 in 2018 including an estimated 117,152 surviving infants
Eritrea has maintained more than 90% coverage with the first dose of measles vaccine at national level since 2001 and 88% MCV2 coverage from 2015 - 2017 according to the WHO-UNICEF coverage estimates
In addition to the analysis of data from the case-based measles surveillance database, we reviewed the official number of measles cases reported by the country annually to WHO and UNICEF through the Joint Reporting Form (JRF) [10]
Summary
Eritrea has a projected total population of 3,905,066 in 2018 including an estimated 117,152 surviving infants. Children less than 5 years of age are estimated to make up 15% of the total population. The country is divided into six administrative regions known as Zobas: Gash Barka, Anseba, Debub, Maekel, Debubawi Keih Bahri and Semanawi Keih Bahri Zobas (Zones), which in turn are divided into 58 subzobas (sub-zones) [1]. The 2018 report of the UN Inter-Agency Group for Child Mortality Estimation indicates that, in Eritrea, under-five mortality rate was reduced from 151 per 1,000 live births in 1990 to 43 per 1,000 live births in 2017. Infant mortality rate was reduced from 93 per 1,000 live births in 1990 to 32 per 1,000 live births in 2017 [2].
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